Prevalence of body-focused repetitive behaviors in three large medical colleges of Karachi: a cross-sectional study.

Background: Body-focused repetitive behaviors (BFRBs) that include skin picking (dermatillomania), hair pulling (trichotillomania) and nail biting (onychophagia), lead to harmful physical and psychological sequelae. The objective was to determine the prevalence of BFRBs among students attending three large medical colleges of Karachi. It is imperative to come up with frequency to design strategies to decrease the burden and adverse effects associated with BFRBs among medical students. Methods: A cross-sectional study was conducted among 210 students attending Aga Khan University, Dow Medical College and Sind Medical College, Karachi, in equal proportion. Data were collected using a pre tested tool, “Habit Questionnaire”. Diagnoses were made on the criteria that a student must be involved in an activity 5 times or more per day for 4 weeks or more. Convenience sampling was done to recruit the participants aged 18 years and above after getting written informed consent. Results: The overall prevalence of BFRBs was found to be 46 (22%). For those positive for BFRBs, gender distribution was as follows: females 29 (13.9%) and males 17 (8.1%). Among these students, 19 (9.0%) were engaged in dermatillomania, 28 (13.3%) in trichotillomania and 13 (6.2%) in onychophagia. Conclusions: High proportions of BFRBs are reported among medical students of Karachi. Key health messages and interventions to reduce stress and anxiety among students may help in curtailing the burden of this disease which has serious adverse consequences

Facies Analysis and Sedimentary Architecture of Hybrid Event Beds in Submarine Lobes: Insights from the Crocker Fan, NW Borneo, Malaysia

Hybrid event beds represent the combined effect of multiple geological processes, which result in complex depositional geometries and distinct facies distribution in marine environments. Previous work on hybrid event beds highlights the classification, origin, and types of hybrid facies. However, in the present study, we discuss the development of hybrid event beds in submarine lobes with an emphasis on the analysis of proximal to distal, frontal to lateral relationships and evolution during lobe progradation. Detailed geological fieldwork was carried out in the classical deep-marine Late Paleogene Crocker Fan to understand the relationship between the character of hybrid bed facies and lobe architecture. The results indicate that hybrid facies of massive or structureless sandstone with mud clasts, clean to muddy sand, and chaotic muddy sand with oversized sand patch alternations (H1–H3) are well developed in proximal to medial lobes, while distal lobes mainly contain parallel to cross-laminated clean to muddy hybrid facies (H3–H5). Furthermore, lateral lobes have less vertical thickness of hybrid beds than frontal lobes. The development of hybrid beds takes place in the lower part of the thickening upward sequence of lobe progradation, while lobe retrogradation contains hybrid facies intervals in the upper part of stratigraphy. Hence, the development of hybrid beds in submarine lobe systems has a significant impact on the characterization of heterogeneities in deep-marine petroleum reservoirs at sub-seismic levels

Aseismic and seismic impact on development of soft-sediment deformation structures in deep-marine sand-shaly Crocker fan in Sabah, NW Borneo

Abstract Soft-sediment deformation structures are present within the deep-marine fan of the West Crocker Formation, Sabah Basin, NW Borneo. Focus of this study is to highlight the impact of seismic and aseismic activities on the development of these structures and their distribution in deep-marine fan. Twenty-nine types of deformation structures were identified during the study of twelve exposed sections. These structures were grouped into five categories: i) water-escape structures, ii) sole marks, iii) clastic intrusions, iv) deformed laminations, and v) syn-depositional brittle and ductile deformation structures. The sediment deformation is interpreted to be caused either by aseismic processes like slope failure, gravity collapse, sediment overloading, density gradient, seismic induced mechanisms such as earthquakes, tectonic uplift, or combined effect of seismic and aseismic events. These structures are classified based on type of features developed during semi-consolidated phase of rock deposition. The seismite structures i.e., clastic intrusions, deformed laminations, and syn-depositional structures are correlated with active collisional tectonics during the Late Paleogene times in the Sabah Basin. In the present work, a generalized conceptual model has also been proposed for the development of soft-sediment deformation structures in a submarine fan environment. Dewatering structurers and rapid sedimentation features are associated with inner fan, load and flame structures are present within middle fan, while contorted layers, slumps and mass-transport deposits are linked with distal fan settings

Nanoparticle shape effects on squeezed MHD flow of water based Cu, Al2O3 and SWCNTs over a porous sensor surface

Impact of nanoparticle shape on the squeezed MHD flow of water based metallic nanoparticles over a porous sensor surface in the presence of heat source has been investigated. In distinctly most paramount studies, three distinctive forms of nanoparticle shapes are employed into account, i.e. sphere ðm ¼ 3:0Þ, cylinder ðm ¼ 6:3698Þ and laminar ðm ¼ 16:1576Þ. The controlling partial differential equations (PDEs) are regenerated into ordinary differential equations (ODEs) by manipulating consistent conformity conversion and it is determined numerically by handling Runge Kutta Fehlberg method with shooting technique. It is noticed that the solid volume fraction and nanoparticle shape have powerful outputs in squeezing flow phenomena, the sphere shape nanoparticle in Cu – water and cylindrical shape in SWCNTs-water in the presence of magnetic field along with thermal radiation energy has better improvement on heat transfer as compared with the other nanoparticle shapes in different flow regimes

Comparison of Fibrosis-4 with FibroScan for Liver Fibrosis Assessment in Non-Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study

Objective: To identify the relationship between injection needle threat as a mode of disciplining children and acquired dental phobia in pediatric patients. Methods: This cross-sectional study was conducted at University College of Dentistry, Lahore, Pakistan between December 2021 and November 2022. The study included individuals under the age of 18 years who were presented during the survey and scheduled for pulpotomy or pulpectomy treatment. The study assessed two primary outcomes: dental anxiety and childhood needle threat. Dental anxiety was evaluated using the Modified Children's Dental Anxiety Scale, while childhood needle threat was measured by observing the child's responses to scenarios involving needles. Results: Of total 200 pediatric patients, the mean age was 12.04 ±2.34 years. Mild dental anxiety level was observed in 56 (28.0%) patients, moderate in 122 (61.0%) patients and severe in 22 (11.0%) patients. Childhood needle threat was observed in 94 (47.0%) patients. Patients with mild dental anxiety were 0.86 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.14, 95% CI 0.04 to 0.48, p-value 0.002). Similarly, patients with moderate dental anxiety were 0.83 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.17, 95% CI 0.05 to 0.55, p-value 0.003). Conclusion: The study revealed that most children exhibited moderate dental anxiety, with a notable incidence of dental phobia. Those with higher anxiety levels felt more threatened by needles, underscoring the need to avoid using needles as a mode of discipline

Comparison of Fibrosis-4 with FibroScan for Liver Fibrosis Assessment in Non-Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study

Objective: To identify the relationship between injection needle threat as a mode of disciplining children and acquired dental phobia in pediatric patients. Methods: This cross-sectional study was conducted at University College of Dentistry, Lahore, Pakistan between December 2021 and November 2022. The study included individuals under the age of 18 years who were presented during the survey and scheduled for pulpotomy or pulpectomy treatment. The study assessed two primary outcomes: dental anxiety and childhood needle threat. Dental anxiety was evaluated using the Modified Children's Dental Anxiety Scale, while childhood needle threat was measured by observing the child's responses to scenarios involving needles. Results: Of total 200 pediatric patients, the mean age was 12.04 ±2.34 years. Mild dental anxiety level was observed in 56 (28.0%) patients, moderate in 122 (61.0%) patients and severe in 22 (11.0%) patients. Childhood needle threat was observed in 94 (47.0%) patients. Patients with mild dental anxiety were 0.86 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.14, 95% CI 0.04 to 0.48, p-value 0.002). Similarly, patients with moderate dental anxiety were 0.83 times significantly less likely to have needle threat as compared to patients with severe dental anxiety (cOR 0.17, 95% CI 0.05 to 0.55, p-value 0.003). Conclusion: The study revealed that most children exhibited moderate dental anxiety, with a notable incidence of dental phobia. Those with higher anxiety levels felt more threatened by needles, underscoring the need to avoid using needles as a mode of discipline

Medicinal potential of isoflavonoids: Polyphenols that may cure diabetes

In recent years, there is emerging evidence that isoflavonoids, either dietary or obtained from traditional medicinal plants, could play an important role as a supplementary drug in the management of type 2 diabetes mellitus (T2DM) due to their reported pronounced biological effects in relation to multiple metabolic factors associated with diabetes. Hence, in this regard, we have comprehensively reviewed the potential biological effects of isoflavonoids, particularly biochanin A, genistein, daidzein, glycitein, and formononetin on metabolic disorders and long-term complications induced by T2DM in order to understand whether they can be future candidates as a safe antidiabetic agent. Based on in-depth in vitro and in vivo studies evaluations, isoflavonoids have been found to activate gene expression through the stimulation of peroxisome proliferator-activated receptors (PPARs) (α, γ), modulate carbohydrate metabolism, regulate hyperglycemia, induce dyslipidemia, lessen insulin resistance, and modify adipocyte differentiation and tissue metabolism. Moreover, these natural compounds have also been found to attenuate oxidative stress through the oxidative signaling process and inflammatory mechanism. Hence, isoflavonoids have been envisioned to be able to prevent and slow down the progression of long-term diabetes complications including cardiovascular disease, nephropathy, neuropathy, and retinopathy. Further thoroughgoing investigations in human clinical studies are strongly recommended to obtain the optimum and specific dose and regimen required for supplementation with isoflavonoids and derivatives in diabetic patients

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030